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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201271
Report Date: 07/26/2023
Date Signed: 07/26/2023 02:36:28 PM

Document Has Been Signed on 07/26/2023 02:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:LAS TRAMPAS - SHEILA HOUSEFACILITY NUMBER:
079201271
ADMINISTRATOR:RUBIO, MARTHAFACILITY TYPE:
740
ADDRESS:9 SHEILA COURTTELEPHONE:
(925) 300-3839
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 4CENSUS: 4DATE:
07/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:11 PM
MET WITH:Martha Rubio, Assistant Director of ResidentialTIME COMPLETED:
02:50 PM
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On 07/26/2023 at 2:11 PM, Licensing Program Analyst (LPA) L. Alexander conducted a Component III Review, for the Pre-licensing Inspection which was conducted on this date with Martha Rubio, Assistant Director of Residential.

LPA presented Component III power point during visit and discussed the regulations embodied in the power point. LPA observed the participant gained knowledge about running and maintaining the facility in accordance with regulations.

Exit interview conduct and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Lori Alexander-Washington
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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